Need help! Is an ablative or non-ablative laser best for my type of acne scars? (Photo)

Hi, I went to two doctors experienced in treating acne scars and one suggested a non-ablative fraxel laser 4-6 treatments, while the other said full laser resurfacing with an ablative laser would be give me better results and he said one treatment maybe two would be necessary, but more downtime. I definitely want the best option/results so it makes sense to go the ablative laser route but now I'm questioning why they had differing opinions and wanted to know what I should do. Thanks

Doctor Answers 3

Box car, ice pick scars use of fraxel and ablative versus non ablative resurfacing

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I personally think non-ablative resurfacing will not work at all. Laser resurfacing will work and can improve your scars, especially your ice pick scars. But you have to apply the laser resurfacing in a different way with certain types of scars. Traditional approaches with laser resurfacing and other forms of ablative resurfacing including chemical peels, dermabrasion won't fully improve your ice pick scars unless it's implied in a special manner. Also your rolling and box car scars won't completely improve without treating some of the surface layer and deeper layers of the skin together and with the same treatment. It took me 15 years to figure out how to treat all types of acne scars through constant Improvement. I basically took 15 years combining treatments in different ways at different time points. I have found that combining them in a special way can really improve your acne scarring. We would love to help you!

Bellevue Facial Plastic Surgeon

Subcision Works Well For Elevating Depressed Scars & Microneedling For Treating Tone & Texture Problems

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From what I can see from the photos provided, you would probably do quite well with the use of subcision to raise up any of the indented rolling scars present followed by microneedling,  a relatively inexpensive approach, for blending the color and texture of the treated skin with the surrounding normal skin. Ablative lasering tends to have extended downtime and carries with it the potential risks of temporary and even permanent dyspigmentation and scarring. And fraxel lasers and radiofrequency devices and other "newest," next best thing-"-to-come-along gizmos, in my experience, have to date yielded disappointingly subtle, variable, and inconsistent results and appear to be supported far more by device manufacturer backed marketing hype than hard science. Since acne scars come in a variety of forms, to be truly effective and cost effective, treatment plans need to be individualized. I would suggest seeking a third opinion by a board certified aesthetic physician with experience and expertise in scar removal and maintaining a high level of skepticism if presented with any one-size-fits-all treatment recommendations. Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Ablative versus Non-ablative Laser

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You can get treatment for acne scars with either but most patients prefer acne scar treatments with Fraxel Dual or eMatrix to avoid weeks of redness and downtime.  You can have the same excellent results without significant discomfort and a long recovery. For a few of the deeper scars you might need a small amount of filler.  Please consult an expert for the best cosmetic results.  Best, Dr. Green

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